Effect of an Albumin Infusion Treatment Protocol on Delayed Cerebral Ischemia and Relevant Outcomes in Patients with Subarachnoid Hemorrhage

Un protocolo de manejo institucional para pacientes con hemorragia subaracnoidea (HSA) basado en la evaluación cardíaca inicial, la permisividad de los balances negativos de líquidos y el uso de una infusión continua de albúmina como fluidoterapia principal durante los primeros 5 días de estancia en la unidad de cuidados intensivos (UCI). se implementó en nuestro hospital en 2014. Tenía como objetivo lograr y mantener la euvolemia y la estabilidad hemodinámica para prevenir eventos isquémicos y complicaciones en la UCI reduciendo los períodos de hipovolemia o inestabilidad hemodinámica. Este estudio tuvo como objetivo evaluar el efecto del protocolo de manejo implementado sobre la incidencia de isquemia cerebral retardada (ICD), la mortalidad y otros resultados relevantes en pacientes con HSA durante la estancia en la UCI.Q1Background An institutional management protocol for patients with subarachnoid hemorrhage (SAH) based on initial cardiac assessment, permissiveness of negative fluid balances, and use of a continuous albumin infusion as the main fluid therapy for the first 5 days of the intensive care unit (ICU) stay was implemented at our hospital in 2014. It aimed at achieving and maintaining euvolemia and hemodynamic stability to prevent ischemic events and complications in the ICU by reducing periods of hypovolemia or hemodynamic instability. This study aimed at assessing the effect of the implemented management protocol on the incidence of delayed cerebral ischemia (DCI), mortality, and other relevant outcomes in patients with SAH during ICU stay. Methods We conducted a quasi-experimental study with historical controls based on electronic medical records of adults with SAH admitted to the ICU at a tertiary care university hospital in Cali, Colombia. The patients treated between 2011 and 2014 were the control group, and those treated between 2014 and 2018 were the intervention group. We collected baseline clinical characteristics, cointerventions, occurrence of DCI, vital status after 6 months, neurological status after 6 months, hydroelectrolytic imbalances, and other SAH complication. Multivariable and sensitivity analyses that controlled for confounding and considered the presence of competing risks were used to adequately estimate the effects of the management protocol. The study was approved by our institutional ethics review board before study start. Results One hundred eighty-nine patients were included for analysis. The management protocol was associated with a reduced incidence of DCI (hazard ratio 0.52 [95% confidence interval 0.33–0.83] from multivariable subdistribution hazards model) and hyponatremia (relative risk 0.55 [95% confidence interval 0.37–0.80]). The management protocol was not associated with higher hospital or long-term mortality, nor with a higher occurrence of other unfavorable outcomes (pulmonary edema, rebleeding, hydrocephalus, hypernatremia, pneumonia). The intervention group also had lower daily and cumulative administered fluids compared with historic controls (p < 0.0001). Conclusions A management protocol based on hemodynamically oriented fluid therapy in combination with a continuous albumin infusion as the main fluid during the first 5 days of the ICU stay appears beneficial for patients with SAH because it was associated with reduced incidence of DCI and hyponatremia. Proposed mechanisms include improved hemodynamic stability that allows euvolemia and reduces the risk of ischemia, among others.Revista Internacional - IndexadaS

Young ages and other intriguing properties of massive compact galaxies in the Local Universe

We characterize the kinematics, morphology, stellar populations and star formation histories of a sample of massive compact galaxies in the nearby Universe, which might provide a closer look to the nature of their high redshift (z > 1.0) massive counterparts. We find that nearby compact massive objects show elongated morphologies and are fast rotators. New high-quality long-slit spectra show that they have young mean luminosity-weighted ages (< 2Gyr) and solar metallicities or above ([Z/H]> 0.0). No significant stellar population gradients are found. The analysis of their star formation histories suggests that these objects have experienced recently enormous bursts which, in some cases, represent unprecedented large fractions of their total stellar mass. These galaxies seem to be truly unique, as they do not follow the characteristic kinematical and stellar population patterns of present-day massive ellipticals, spirals or even dwarfs.Comment: 16 pages, 11 figures; Accepted for publication in MNRA

Satellites around massive galaxies since z~2

Accretion of minor satellites has been postulated as the most likely mechanism to explain the significant size evolution of the massive galaxies over cosmic time. Using a sample of 629 massive (Mstar~10^11 Msun) galaxies from the near-infrared Palomar/DEEP-2 survey, we explore which fraction of these objects has satellites with 0.01 Msat < Mcentral < 1 (1:100) up to z=1 and which fraction has satellites with 0.1 Msat < Mcentral < 1 (1:10) up to z=2 within a projected radial distance of 100 kpc. We find that the fraction of massive galaxies with satellites, after the background correction, remains basically constant and close to ~30% for satellites with a mass ratio down to 1:100 up to z=1, and ~15% for satellites with a 1:10 mass ratio up to z=2. The family of spheroid-like massive galaxies presents a 2-3 times larger fraction of objects with satellites than the group of disk-like massive galaxies. A crude estimation of the number of 1:3 mergers a massive spheroid-like galaxy experiences since z~2 is around 2. For a disk-like galaxy this number decreases to ~1.Comment: 8 pages, 7 figures, 2 tables. Submitted to MNRAS on Sept. 23, resubmitted after addressing referee comment

ENM2020 : A FREE ONLINE COURSE AND SET OF RESOURCES ON MODELING SPECIES NICHES AND DISTRIBUTIONS

The field of distributional ecology has seen considerable recent attention, particularly surrounding the theory, protocols, and tools for Ecological Niche Modeling (ENM) or Species Distribution Modeling (SDM). Such analyses have grown steadily over the past two decades-including a maturation of relevant theory and key concepts-but methodological consensus has yet to be reached. In response, and following an online course taught in Spanish in 2018, we designed a comprehensive English-language course covering much of the underlying theory and methods currently applied in this broad field. Here, we summarize that course, ENM2020, and provide links by which resources produced for it can be accessed into the future. ENM2020 lasted 43 weeks, with presentations from 52 instructors, who engaged with >2500 participants globally through >14,000 hours of viewing and >90,000 views of instructional video and question-and-answer sessions. Each major topic was introduced by an "Overview" talk, followed by more detailed lectures on subtopics. The hierarchical and modular format of the course permits updates, corrections, or alternative viewpoints, and generally facilitates revision and reuse, including the use of only the Overview lectures for introductory courses. All course materials are free and openly accessible (CC-BY license) to ensure these resources remain available to all interested in distributional ecology.Peer reviewe

Infectious Diseases, Social, Economic and Political Crises, Anthropogenic Disasters and Beyond: Venezuela 2019 – Implications for Public Health and Travel Medicine

During last months, there have been a significant increase in the evidences showing the catastrophic health situation in Venezuela. There are multiple epidemics, increase in emerging and reemerging infectious, tropical and parasitic diseases as consequences of the social, economic and political crises, which would be considered today a clearly anthropogenic disaster. Venezuela is facing in 2019, the worse sanitary conditions, with multiple implications for public health and travel medicine. So far, from a global perspective, this situation will be an impediment for the achievement of the sustainable development goals (SDG) in 2030. In this multiauthor review, there is a comprehensive analysis of the situation for infectious diseases, non-communicable diseases, their impact in the Americas region, given the migration crisis as well as the comparative status of the SDG 2030. This discussion can provide input for prioritizing emerging health problems and establish a future agenda

Infectious Diseases, Social, Economic and Political Crises, Anthropogenic Disasters and Beyond: Venezuela 2019 – Implications for Public Health and Travel Medicine

During last months, there have been a significant increase in the evidences showing the catastrophic health situation in Venezuela. There are multiple epidemics, increase in emerging and reemerging infectious, tropical and parasitic diseases as consequences of the social, economic and political crises, which would be considered today a clearly anthropogenic disaster. Venezuela is facing in 2019, the worse sanitary conditions, with multiple implications for public health and travel medicine. So far, from a global perspective, this situation will be an impediment for the achievement of the sustainable development goals (SDG) in 2030. In this multiauthor review, there is a comprehensive analysis of the situation for infectious diseases, non-communicable diseases, their impact in the Americas region, given the migration crisis as well as the comparative status of the SDG 2030. This discussion can provide input for prioritizing emerging health problems and establish a future agenda

A Functional Role of RB-Dependent Pathway in the Control of Quiescence in Adult Epidermal Stem Cells Revealed by Genomic Profiling

Continuous cell renewal in mouse epidermis is at the expense of a pool of pluripotent cells that lie in a well defined niche in the hair follicle known as the bulge. To identify mechanisms controlling hair follicle stem cell homeostasis, we developed a strategy to isolate adult bulge stem cells in mice and to define their transcriptional profile. We observed that a large number of transcripts are underexpressed in hair follicle stem cells when compared to non-stem cells. Importantly, the majority of these downregulated genes are involved in cell cycle. Using bioinformatics tools, we identified the E2F transcription factor family as a potential element involved in the regulation of these transcripts. To determine their functional role, we used engineered mice lacking Rb gene in epidermis, which showed increased expression of most E2F family members and increased E2F transcriptional activity. Experiments designed to analyze epidermal stem cell functionality (i.e.: hair regrowth and wound healing) imply a role of the Rb-E2F axis in the control of stem cell quiescence in epidermis

Euclid preparation: XVI. Exploring the ultra-low surface brightness Universe with Euclid /VIS

Context. While Euclid is an ESA mission specifically designed to investigate the nature of dark energy and dark matter, the planned unprecedented combination of survey area (∼15â 000 deg2), spatial resolution, low sky-background, and depth also make Euclid an excellent space observatory for the study of the low surface brightness Universe. Scientific exploitation of the extended low surface brightness structures requires dedicated calibration procedures that are yet to be tested. Aims. We investigate the capabilities of Euclid to detect extended low surface brightness structure by identifying and quantifying sky-background sources and stray-light contamination. We test the feasibility of generating sky flat-fields to reduce large-scale residual gradients in order to reveal the extended emission of galaxies observed in the Euclid survey. Methods. We simulated a realistic set of Euclid/VIS observations, taking into account both instrumental and astronomical sources of contamination, including cosmic rays, stray-light, zodiacal light, interstellar medium, and the cosmic infrared background, while simulating the effects of background sources in the field of view. Results. We demonstrate that a combination of calibration lamps, sky flats, and self-calibration would enable recovery of emission at a limiting surface brightness magnitude of μlim = 29.5-0.27+0.08 mag arcsec-2 (3σ, 10â ×â 10 arcsec2) in the Wide Survey, and it would reach regions deeper by 2 mag in the Deep Surveys. Conclusions.Euclid/VIS has the potential to be an excellent low surface brightness observatory. Covering the gap between pixel-To-pixel calibration lamp flats and self-calibration observations for large scales, the application of sky flat-fielding will enhance the sensitivity of the VIS detector at scales larger than 1″, up to the size of the field of view, enabling Euclid to detect extended surface brightness structures below μlimâ =â 31 mag arcsec-2 and beyond

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p&lt;0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p&lt;0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations